<tal:block metal:define-macro="standard">
  <div class="well">
    <form>
      <div class="form-group">
        <label for="contactName">Name</label>
        <input type="email" class="form-control" id="contactName" placeholder="Enter your name" />
      </div>
      <div class="form-group">
        <label for="contactEmail">Email</label>
        <input type="email" class="form-control" id="contactEmail" placeholder="Enter email" />
        <p class="help-block">Make sure you use a valid email address</p>
      </div>
      <div class="form-group">
        <label for="contactComment">Comment</label>
        <textarea class="form-control" id="contactComment"></textarea>
      </div>
      <button type="submit" class="btn btn-default">Submit</button>
    </form>
  </div>
</tal:block>